Non-Covered Services Fee at OSFM

Tracy McDaniel • March 22, 2022

Hello dear OSFM family. We have news, and it’s been a long time coming… Over the past several years the practice of primary care medicine has been changing rapidly, in terms of both cost and complexity. You may or may not know that small, independent primary care practices are disappearing at an alarming rate. Most primary care practices today are owned and operated by large medical centers with significant resources, connected to and funded by their specialty clinics. We have spent the last several years trying to navigate how to survive and thrive in a model designed for large practices with doctors seeing more than 30 patients a day and who are doing 6–15-minute visits. That's not who we are. 

 

At OSFM, we offer comprehensive, integrative, naturopathic family medicine. Doing so takes time, mindfulness, and resources in a way that is a mismatch with the current insurance model. We have found that we spend a sizable portion of each day providing “Non-Covered Services”, as they’re known in the healthcare world, and that doing so has begun to affect our ability to keep the clinic running smoothly. These Non-Covered Services are an important part of providing holistic care for you and your family. Rather than limiting these activities, we have decided to embrace them and more intentionally carve out staff time and resources to do them and do them well. To do this, we’ll need your help. 

 

We have looked at this puzzle from every angle. We have crafted a solution and, in the process, gained clarity about what must be protected. We will: 


  • Stay an independent practice, and are not interested in merging with one of the big institutions 
  • Continue to accept insurance and manage insurance billing for the people we provide care for 
  • Contract with insurance plans that reimburse adequately and will stop working with insurance plans that don’t 
  • Prioritize health plans that cover people with lower incomes
  • Continue to provide affordable cash-pay options for people who do not use insurance to pay for their care 
  • Manage our practice size and schedule to remain a “small practice” so we can continue to provide highly personalized care and schedule you quickly when you need a visit 
  • Remain committed to protecting the length of our visits, allowing spaciousness so that we can cover what is needed rather than joining the race, making each doctor move faster, seeing more people in less time 
  • Cultivate a clinic environment that allows us to be available to you during important medical milestones 

 

So, what does this mean for you? Beginning May 1, 2022, we will be joining a movement among small practices intended to protect our way of providing care. We will be instituting a Non-Covered Services Fee for all patients in the practice. This out-of-pocket monthly or per-visit fee will cover the cost of administrative and care coordination services we provide that are NOT covered by your insurance. This is a hybrid approach, as we WILL continue to bill insurance as we always have for the health care services that they cover and will institute the Non-Covered Services fee only for non-covered services. We wanted to give you plenty of notice and time to plan and ask questions. 

 

What are “Non-Covered Services”? Non-Covered Services are all the things we do that insurance plans will not pay for and which are complementary to our healthcare services. These services are not considered “medically necessary” by insurers or are not covered unless provided on the day of your visit. These Non-Covered Services are not direct patient care, but consist of the communication, administrative work, and care coordination services we provide to ensure that you and your family are receiving the most comprehensive and holistic wellness care we can offer.    Some examples of these services include:

  • Portal messaging between visits with a provider. This has become a significant part of our care and a major way we communicate with people. 
  • Administrative work such as completing sports physical forms, vaccine certificates, FMLA and disability paperwork when needed outside of a visit 
  • Insurance coordination and support, including pre-authorizations for medications, imaging, and procedures, advocating for reimbursement based on medical necessity for naturopathic testing and treatment 
  • Troubleshooting pharmacy and lab issues 
  • Pandemic response, planning and education 

 

Options.  We know you each interact with us differently, so we have designed our approach to give you options. You can choose to pay at each visit or opt into a lower monthly payment that covers these services all year long. 

 

  • Monthly Non-Covered Services Fee $29/month for an individual, $75/month max for a family. This monthly plan is for those of you who want to continue to get the collaborative care and services that you have come to expect from OSFM, without needing to come in for a visit or pay separately each time you have a question or need support. 
  • Per-Visit Fee for Non-Covered Services $45/visit  Some of you only see us rarely or come in for a visit each time you have a question or need support. You don’t message on the portal and hardly ever ask questions or need recommendations between visits. You don't need forms, lab or pharmacy help from us except right around the time of your visit. This may be the option for you. This per-visit-fee will be an add-on charge each time you have a clinic visit and will cover the usual burst of Non-Covered Services for 2 weeks after your visit. 
  • Patients who are Self-Pay (no insurance) We’ve included the per-visit level of support built into the cost of the visit and patients will have 2 weeks of support following their visit included. This applies to situations where we will not be submitting any claim to a health plan. If you would like to have access to the Non-Covered Services between visits, we recommend choosing the monthly option. 

 

You can find a copy of the Non-Covered Services Agreement HERE

If you select the Monthly option, consider signing up before May 1st and set up automatic payment and you will get the first 2 months free. 

 

We deeply value the relationship we have with each of you. This shift will help us preserve our ability to tend you in a system that wants faster, bigger, more algorithmic healthcare when we KNOW that this time calls for exactly the opposite. Thank you for supporting us as we deepen our resilience and allow us to continue offering you the independent naturopathic primary care you want and expect.


For more information visit www.oneskyfamilymedicine.com, send us a message on the portal or give us a call if you'd like to talk more about these options. 

 

Yours in Health, 

The One Sky Family Medicine team

Share by: